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Smoking cessation is the principal means by which a current cigarette smoker can alter his or her future risk of disease. Prevention of smoking initiation among adolescents can reduce smoking prevalence, but adolescents contribute little to rates of smoking-related illness until they have been smoking for 30 or more years. Cessation is often examined at the individual level in order to deter-mine the effects of cessation interventions or to define individual predictors of who will or will not be successful in their cessation attempts. However, for these individual effects to create a substantive public health benefit, they must sum to create a significant change at the population level. Powerful interventions that affect only a few individuals will have little impact on disease rates, whereas weaker interventions that impact large numbers of smokers will have important and cumulative effects on disease rates. In addition, many interventions (e.g., price increases, changes in social norms, etc.) are delivered to the population as a whole rather than to individual smokers one at a time, and it is these population-based interventions that have formed the core of the tobacco control efforts currently underway in California, Massachusetts, and several other states. This volume examines cessation at the population level. By population level, we mean that all segments of society form the denominator for evaluation of the effectiveness of tobacco control interventions. Therefore, this volume relies heavily on representative surveys of smoking behaviors in state and national populations. By doing so, it defines measures of cessation that can be used to assess the effects of tobacco control programs or public policy changes on smoking behavior. It then uses those measures to identify who is quitting, who is being successful, who is being exposed to various tobacco control interventions, and which tobacco control interventions are proving effective.

PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event. When in danger, it's natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This "fight-or-flight" response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they're no longer in danger. Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. PTSD can cause many symptoms. These symptoms can be grouped into three categories: 1. Re-experiencing symptoms: Flashbacks-reliving the trauma over and over, including physical symptoms like a racing heart or sweating; Bad dreams; Frightening thoughts. Re-experiencing symptoms may cause problems in a person's everyday routine. They can start from the person's own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing. 2. Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience; Feeling emotionally numb; Feeling strong guilt, depression, or worry; Losing interest in activities that were enjoyable in the past; Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. 3. Hyperarousal symptoms: Being easily startled; Feeling tense or "on edge"; Having difficulty sleeping, and/or having angry outbursts. Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. It's natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don't show any symptoms for weeks or months.

When Your Brother or Sister Has Cancer: A Guide for Teens, National Institutes of Health Publication 06-5733: If your brother or sister has cancer, this book is for you. In this book you will hear from other teens who, like you, have a brother or sister with cancer, find out what has helped them, get ideas about people to talk with when you're upset or fell all alone, and learn a little about cancer and how it's treated. This book can't give you all the answers, but it can help you prepare for some of the things you might face. There is a team of people working hard to help your brother or sister get better. You should know that there are also many people available to help you. No one should go through this alone. This book provides information about cancer treatments, ways teens can talk to family and friends, how to connect with other teens, and where to find other resources for information and support. It includes a glossary of cancer terms and appendices explaining monitoring tests and members of the cancer team.

Large-scale consumption of tobacco has been a significant lifestyle factor in America for centuries . Prior to the beginning of the 20th century, tobacco was consumed in the form of spitting tobacco (chewing tobacco and snuff), smoked as cigars, or loose tobacco smoked in pipes or in hand-rolled cigarettes. Consumption of machine-made cigarettes was almost nonexistent, and spitting tobacco was the dominate form of use, accounting for nearly 60 percent of all tobacco consumed on a per capita basis. Consumption of machine-manufactured cigarettes increased dramatically following World War I; by 1935, more tobacco was being consumed in the form of cigarettes than all other products combined. As the popularity of cigarettes continued to increase, consumption of noncigarette tobacco products, especially smokeless tobacco, declined. Per capita cigarette tobacco consumption peaked in the early 1950's (as did total per capita tobacco consumption), probably in response both to the first scientific studies linking cigarette smoking to lung cancer and to the introduction and aggressive promotion of filter cigarettes by the cigarette industry in response to these early scientific findings. Filter cigarettes, which had previously accounted for less than 1 percent of all cigarettes consumed in the United States in 1950, had captured 50 percent of the market by the end of the decade, and today account for over 90 percent of all cigarette sales. In comparison to their nonfilter counterparts, filter cigarettes generally contain less tobacco. For decades following the introduction of the mass-produced and mass marketed cigarettes, consumption and prevalence of smokeless tobacco had been on the decline. However, the latter part of the 1970's and the early part of the 1980's, saw major increases in ST use. This increase was the result of renewed and more aggressive advertising by the ST industry that accompanied the introduction of innovative products such as Skoal Bandits-and the use of well-known sport and entertainment personalities in ST promotions . Personalities such as football stars Walt Garrison and Terry Bradshaw; baseball greats George Brett, Sparky Lyle, Carlton Fisk, and Bobby Murcer; and country-and-western singer Charlie Daniels, obviously appealed to a very young and impressionable audience. Furthermore, use of broadcast media to promote ST was not prohibited under the existing Congressional legislation that had governed cigarettes since 1971; thus, the ST industry was free to use television to recruit a large and relatively untapped market of new users. Because the themes and images used appealed primarily to children and adolescents, increases in ST consumption that occurred during the 1980's was primarily confined to these age groups . Where previously little or no use of ST was seen among adolescents, prevalence of ST use among older teens increased between 250 and 300 percent between 1970 and 1985. Compared with cigarettes, we know much less about the factors influencing ST use. Only in the past few years have the research results elucidated the many facets of ST use and means to intervene in this process. This monograph represents the most recent major attempt to bring together the important research findings of the last few years. Previous compilations of ST research have been the U.S. Surgeon General's Report in 1986 and a monograph published by the National Cancer Institute in 1989, titled Smokeless Tobacco Use in the United States. The present monograph will use the model established by the two previous publications in presenting as broad a picture of the ST problem as possible. Sections in this monograph describe the epidemiology, clinical and pathological effects, carcinogenesis, nicotine effects and addiction, prevention, cessation, and policy research findings in the area of ST use. Finally, recommendations based on research and compiled by experts in the field is presented.

Maybe in the back of your mind, you feared that your cancer might return. Now you might be thinking, "How can this be happening to me again? Haven't I been through enough?" You may be feeling shocked, angry, sad, or scared. Many people have these feelings. But you have something now that you didn't have before-experience. You've lived through cancer once. You know a lot about what to expect and hope for. Also remember that treatments may have improved since you had your first cancer. New drugs or methods may help with your treatment or in managing side effects. In fact, cancer is now often thought of as a chronic disease, one which people manage for many years. When Cancer Returns: Support for People with Cancer, the National Institutes of Health Publication 11-2709 offers some general advice as you adjust to the news that your cancer has returned. It covers all aspects of your treatment. It outlines basic information regarding cancer recurrence, including communicating with your health care team as well as your family and friends, managing side effects and coping with emotional psychosocial issues. Above all else, remember that your feelings count. There is no "right" way to cope. Some people need a lot of information. Others like a little at a time. Likewise, some sections in this booklet may address your needs. Others may not.

This book by the National Institutes of Health (Publication 06-4082) and the National Heart, Lung, and Blood Institute provides information and effective ways to work with your diet because what you choose to eat affects your chances of developing high blood pressure, or hypertension (the medical term). Recent studies show that blood pressure can be lowered by following the Dietary Approaches to Stop Hypertension (DASH) eating plan-and by eating less salt, also called sodium. While each step alone lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high blood pressure. This book, based on the DASH research findings, tells how to follow the DASH eating plan and reduce the amount of sodium you consume. It offers tips on how to start and stay on the eating plan, as well as a week of menus and some recipes. The menus and recipes are given for two levels of daily sodium consumption-2,300 and 1,500 milligrams per day. Twenty-three hundred milligrams is the highest level considered acceptable by the National High Blood Pressure Education Program. It is also the highest amount recommended for healthy Americans by the 2005 "U.S. Dietary Guidelines for Americans." The 1,500 milligram level can lower blood pressure further and more recently is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve. The lower your salt intake is, the lower your blood pressure. Studies have found that the DASH menus containing 2,300 milligrams of sodium can lower blood pressure and that an even lower level of sodium, 1,500 milligrams, can further reduce blood pressure. All the menus are lower in sodium than what adults in the United States currently eat-about 4,200 milligrams per day in men and 3,300 milligrams per day in women. Those with high blood pressure and prehypertension may benefit especially from following the DASH eating plan and reducing their sodium intake.

This National Institutes of Health Publication 12-5774, "What I Need to Know About Crohn's Disease," provides information on Crohn's disease from understanding the symptoms to obtaining the proper treatment so that you can lead a full, healthy life. Crohn's disease is a disease that causes inflammation, or swelling, and irritation of any part of the digestive tract-also called the gastrointestinal (GI) tract. The part most commonly affected is the end part of the small intestine, called the ileum. Crohn's disease is one of two main forms of diseases of the GI tract named inflammatory bowel disease (IBD). The other form, called ulcerative colitis, affects the large intestine, which includes the colon and the rectum. With Crohn's disease, chronic-or long lasting- inflammation may cause scar tissue to form in the lining of the intestine. When scar tissue builds up, the passage can become narrow, causing food and stool to move through the GI tract more slowly. There are many options for treating Crohn's disease including the proper medicines, diet and nutrition. Most people with Crohn's disease are able to work, raise families, and live full lives.

An estimated 97 million adults in the United States are overweight or obese, a condition that substantially raises their risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. Obese individuals may also suffer from social stigmatization and discrimination. As a major contributor to preventive death in the United States today, overweight and obesity pose a major public health challenge. Overweight is here defined as a body mass index (BMI) of 25 to 29.9 kg/m and obesity as a BMI of 30 kg/m or greater. However, overweight and obesity are not mutually exclusive, since obese persons are also overweight. A BMI of 30 is about 30 lb. overweight and equivalent to 221 lb. in a 6'0" person and to 186 lb. in one 5'6". The number of overweight and obese men and women has risen since 1960; in the last decade the percentage of people in these categories has increased to 54.9 percent of adults age 20 years or older. Overweight and obesity are especially evident in some minority groups, as well as in those with lower incomes and less education. Obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and the environment. Our understanding of how and why obesity develops is incomplete, but involves the integration of social, behavioral, cultural, physiological, metabolic and genetic factors. While there is agreement about the health risks of overweight and obesity, there is less agreement about their management. Some have argued against treating obesity because of the difficulty in maintaining long-term weight loss and of potentially negative consequences of the frequently seen pattern of weight cycling in obese subjects. Others argue that the potential hazards of treatment do not outweigh the known hazards of being obese. The intent of these guidelines is to provide evidence for the effects of treatment on overweight and obesity. The guidelines focus on the role of the primary care practitioner in treating overweight and obesity.

This monograph, the fifth in the NCI Smoking and Tobacco Control series, provides important information for clinicians interested in reducing the tremendous burden of disease caused by cigarettes and other tobacco products. As health professionals we can and must contribute to this effort, both by assisting individual patient cessation and by contributing to broader tobacco control activities in our communities. Cigarette smoking is still this Nation's largest cause of premature death and disability and remains the only product that, when used as intended by the manufacturer, will kill the consumer. Every physician and dentist can and should become a smoking expert to counter the pervasive attempts by the tobacco industry to convince smokers and would-be smokers that smoking is desirable, sexy, or fun. We need to remind ourselves that for decades the cigarette industry blatantly used the medical profession in cigarette advertising and enticed entire generations into believing that smoking was safe. Even today, 30 years after it became known with overwhelming scientific certainty that smoking was a major health threat, cigarette advertisers still portray smoking as free from any significant health risk. Health professionals have been an integral part of the national effort to reduce smoking in the United States, and in fact, the first major smoking information campaign launched by the U.S. Public Health Service was based on changes in physicians' smoking behavior. However, we must do more.

Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. But beginning in July 2002, findings emerged from clinical trials that showed this was not so. In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke. The facts presented in this book by the National Institutes of Health (Publication 05-5200) and the National Heart, Lung and Blood Institute discusses those findings and gives an overview of such topics as menopause, hormone therapy, and alternative treatments for the symptoms of menopause and the various health risks that come in its wake. It also provides a list of sources you can contact for more information.

This guide is intended to help parents understand what autism spectrum disorder (ASD) is, recognize common signs and symptoms, and find the resources they need. It's important to remember that help is available. Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term "spectrum" refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. Some children are mildly impaired by their symptoms, but others are severely disabled. ASD is diagnosed according to guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR). The manual currently defines five disorders, sometimes called pervasive developmental disorders (PDDs), as ASD: Autistic disorder (classic autism); Asperger's disorder (Asperger syndrome); Pervasive developmental disorder not otherwise specified (PDD-NOS); Rett's disorder (Rett syndrome); Childhood disintegrative disorder (CDD). This information packet will focus on autism, Asperger syndrome, and PDD-NOS, with brief descriptions of Rett syndrome and CDD in the section, "Related disorders."

This National Institutes of Health Publication 11-5166, "What I Need to Know About Cirrhosis," provides information about Cirrhosis and liver issues - knowing how to prevent issues, knowing the symptoms of issues and knowing how to receive proper treatment allowing you to lead a full, healthy life. Cirrhosis is scarring of the liver. Scar tissue forms because of injury or long-term disease. Scar tissue replaces healthy liver tissue and blocks the normal flow of blood through the liver. A healthy liver: makes proteins, helps fight infections, cleans the blood, helps digest food, and stores a form of sugar that your body uses for energy. A liver with too much scar tissue cannot work properly. You cannot live without a liver that works. But early treatment can control symptoms and keep cirrhosis from getting worse.

In the months immediately after January 1964, when Surgeon General Luther Terry released the first official Government report on smoking and health, cigarette consumption in the United States declined significantly. It was only the second time since the turn of the century that publicity about the hazards of smoking had produced a reduction in cigarette use. At that time, many leaders in the medical and public health arena assumed that, by providing the public with straightforward information about the dangers of smoking, they could discourage large numbers of people from using cigarettes. While the expected change in behavior did occur, it was far more limited than had been hoped-a reflection of the difficulty that individuals often experience when they attempt to alter a complex behavior such as smoking, especially one we now know to be addictive. The recognition that information alone would not eliminate tobacco use shifted the focus to strategies directed to the individual. This focus presumed, erroneously as it turned out, that the major determinants of smoking behavior were centered within the individual rather than sociologic in nature. Subsequent research and natural observation clearly demonstrated that behavior change correlated with changes occurring in the smoker's social and economic environment. This recognition has led to the adoption of public health strategies that now address the smoker's larger social environment while simultaneously offering programs of assistance for the individual. This volume provides a summary of what we have learned over nearly 40 years of the public health effort against smoking-from the early trial-and-error health information campaigns of the 1960'sto the NCI's science-based ASSIST project (the American Stop Smoking Intervention Study for Cancer Prevention), which began in the fall of 1991. Strategies To Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990's presents a historical accounting of these efforts as well as the reasons why comprehensive smoking control strategies are now needed to address the smoker's total environment and reduce smoking prevalence significantly over the next decade.

The National Institutes of Health Publication 11-6513, "What I Need to Know About Bowel Control," provides background on what Bowel Control means, what it means to have issues, and receiving the proper treatment for any issues you may have. Bowel control means you are able to hold a bowel movement until you reach a bathroom. You may have a bowel control problem if you: have trouble holding a bowel movement, have solid or liquid stool leak when you don't expect it, find streaks of stool on your underwear Bowel control problems-also called fecal incontinence-can be upsetting and embarrassing. Most people with bowel control problems feel ashamed and try to hide the problem. They may not want to leave the house for fear of losing bowel control in public. They may withdraw from friends and family. Bowel control problems are often caused by a medical issue. If you have a bowel control problem, don't be afraid to talk with your health care provider about it. Your health care provider may be able to help. People of any age can have a bowel control problem. Bowel control problems aren't always a part of aging, but they are more common among older adults. Bowel control problems affect about 18 million U.S. adults-one out of every 12 people. Bowel control problems don't have to be a part of aging, but they are more common among older adults. Bowel control problems are often caused by a medical issue that can be treated. Don't be afraid to talk with your health care provider about your bowel control problem. Diet changes, medicines, bowel training, or surgery may help. You can take steps to cope with your bowel control problem.

The first great "public health revolution" in developed countries involved measures to control infectious disease, and now we are in the midst of the second revolution: the massive attack on chronic disease. In this revolution, the dramatic decline in cigarette smoking in the United States since 1964 stands out as the most striking success story, which is especially remarkable considering the fact that antismoking advocates play the part of David against the Goliath of the tobacco industry. Anti-tobacco forces, including public advocacy groups, have made steady advances in controlling the smoking epidemic despite the tobacco industry's greater expenditures to expand tobacco use. The industry's counterattacks continue with steadily increasing intensity; this points to a clear need to increase the scope and effectiveness of all existing educational and regulatory anti-tobacco strategies. This monograph on the Community Intervention Trial for Smoking Cessation (COMMIT) field experience meets this need extraordinarily well because organizing, activating, and empowering communities to take action against smoking surely stands as the most important strategy for use in public health campaigns that emphasize control of tobacco use. This monograph, Community-Based Interventions for Smokers: The COMMIT Field Experience, is one of an excellent series on various aspects of tobacco and health published since 1991 by the National Cancer Institute and the first to deal with community-based approaches. It reports exciting victories: (1) a modest decrease in smoking rates in light-to-moderate smokers, especially in the hard-to-reach categories of individuals of low educational attainment and (2) an impressive accomplishment in community empowerment.

This book by the National Institutes of Health (Publication 06-5269) and the National Heart, Lung, and Blood Institute is designed for both women and men and is an action plan for heart health. It provides up-to-date information and practical tips about establishing and maintaining a heart healthy lifestyle, including understanding the risk factors for heart disease, determining your risk, and establishing a plan for heart heath. If you're like many people, you may think of heart disease as a problem that happens to other folks. "I feel fine," you may think, "so I have nothing to worry about." If you're a woman, you may also believe that being female protects you from heart disease. If you're a man, you may think you're not old enough to have a serious heart condition. Wrong on all counts. In the United States, heart disease is the #1 killer of both women and men. It affects many people at midlife, as well as in old age. It also can happen to those who "feel fine." Consider these facts: Each year, 500,000 Americans die of heart disease, and approximately half of them are women; As early as age 45, a man's risk of heart disease begins to rise significantly. For a woman, risk starts to increase at age 55; Fifty percent of men and 64 percent of women who die suddenly of heart disease have no previous symptoms of the disease. These facts may seem frightening, but they need not be. The good news is that you have a lot of power to protect and improve your heart health. This guidebook will help you find out your own risk of heart disease and take steps to prevent it. "But," you may still be thinking, "I take pretty good care of myself. I'm unlikely to get heart disease." Yet a recent national survey shows that only 3 percent of U.S. adults practice all of the "Big Four" habits that help to prevent heart disease: eating a healthy diet, getting regular physical activity, maintaining a healthy weight, and avoiding smoking. Many young people are also vulnerable. A recent study showed that about two-thirds of teenagers already have at least one risk factor for heart disease. Every risk factor counts. Research shows that each individual risk factor greatly increases the chances of developing heart disease. Moreover, the worse a particular risk factor is, the more likely you are to develop heart disease. For example, if you have high blood pressure, the higher it is, the greater your chances of developing heart disease, including its many serious consequences. A damaged heart can damage your life by interfering with enjoyable activities, preventing you from holding a job, and even keeping you from doing simple things, such as taking a walk or climbing steps. What can you do to reduce your personal risk of heart disease? First, you can learn about your own risk factors. Second, you can begin to make healthful changes in your diet, physical activity, and other daily habits. Whatever your age or current state of health, it's never too late to take steps to protect your heart. It's also never too early. The sooner you act, the better. So use this guidebook to find out more about the state of your heart, and to learn about heart healthy living. Talk with your doctor to get more information. Start taking action to improve your heart health today.

Medications are used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder (sometimes called manic-depressive illness), anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). Sometimes medications are used with other treatments such as psychotherapy. This guide describes: Types of medications used to treat mental disorders; Side effects of medications; Directions for taking medications; Warnings about medications from the U S Food and Drug Administration (FDA). Choosing the right medication, medication dose, and treatment plan should be based on a person's individual needs and medical situation, and under a doctor's care.

Sometimes it seems as if everyone knows someone who is affected by diabetes. More than in 9 African American adults have diabetes. African Americans are .8 times as likely to have diabetes as non-Hispanic whites of the same age . Researchers estimate that if diabetes continues to increase at its current rate, in 3 children born in the year 2000 will develop diabetes in their lifetime-unless something changes. Diabetes can cause heart disease, stroke, kidney failure, lower-limb amputations, and blindness, but it doesn't have to. In many cases it is possible to prevent or delay type 2 diabetes in people at high risk. Scientists who conducted the Diabetes Prevention Program (DPP) study2 found that people can prevent or delay type 2 diabetes by losing some weight (5-7 percent of their weight), eating a healthy diet (low fat, lower calorie), and increasing their physical activity. High-risk adults who participated in the study's "lifestyle modification" activities reduced their risk of developing type 2 diabetes by 58 percent; they lost 5 to 7 percent of their body weight ( 0- 5 pounds for a person weighing 200 pounds) by eating a lower fat diet and having a modest, consistent increase in physical activity (e.g., walking 5 days per week, 30 minutes per day). Dr. James R. Gavin III, past chair of the National Diabetes Education Program (NDEP) and former president of the American Diabetes Association, understands the burden diabetes has placed on the African American community. "Diabetes is a growing epidemic in our communities," notes Dr. Gavin. "If we are going to make a difference, we need to reach people where they live, work, and play." This new NDEP curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention was developed to help bring diabetes prevention and control to African American communities. The Power to Prevent curriculum is composed of 2 sessions that are designed to help people bring healthier habits into their lives to prevent diabetes. These same skills-eating more healthily and increasing physical activity- can also help people who have diabetes control the disease. This curriculum is a companion piece to the NDEP Small Steps. Big Rewards. Prevent Type 2 Diabetes campaign to help the African American community take steps to prevent or delay diabetes. Small Steps. Big Rewards includes tip sheets and booklets such as the GAME PLAN toolkit for diabetes prevention. The aim of the Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention curriculum is to guide people in the use of these NDEP tools and to help them support one another in making changes toward a healthier lifestyle. By taking small steps to implement healthy lifestyle behaviors, African Americans can reap big rewards, such as delaying or preventing type 2 diabetes and its complications.

The National Institutes of Health Publication 07-4051, Guidelines for the Diagnosis and Management of Asthma, The EPR--3 Summary Report 2007, provides key information from the full report on the diagnosis and management of asthma. Summary information is provided on measures of assessment and monitoring, education for a partnership in asthma care, control of environmental factors and comorbid conditions that affect asthma, and medications. Key tables and figures from the full report are included for easy reference. Asthma is a chronic inflammatory disease of the airways. In the United States, asthma affects more than 22 million persons. It is one of the most common chronic diseases of childhood, affecting more than 6 million children (current asthma prevalence, National Health Interview Survey (NHIS), National Center for Health Statistics, Centers for Disease Control and Prevention, 2005) (NHIS 2005). There have been important gains since the release of the first National Asthma Education and Prevention Program (NAEPP) clinical practice guidelines in 1991. For example, the number of deaths due to asthma has declined, even in the face of an increasing prevalence of the disease (NHIS 2005); fewer patients who have asthma report limitations to activities; and an increasing proportion of people who have asthma receive formal patient education (Department of Health and Human Services, Healthy People 2010 midcourse review). Hospitalization rates have remained relatively stable over the last decade, with lower rates in some age groups but higher rates among young children 0-4 years of age. There is some indication that improved recognition of asthma among young children contributes to these rates. However, the burden of avoidable hospitalizations remains. Collectively, people who have asthma have more than 497,000 hospitalizations annually (NHIS 2005). Furthermore, ethnic and racial disparities in asthma burden persist, with significant impact on African American and Puerto Rican populations. The challenge remains to help all people who have asthma, particularly those at high risk, receive quality asthma care. Advances in science have led to an increased understanding of asthma and its mechanisms as well as improved treatment approaches. To help health care professionals bridge the gap between current knowledge and practice, the NAEPP of the National Heart, Lung, and Blood Institute (NHLBI) has previously convened three Expert Panels to prepare guidelines for the diagnosis and management of asthma. The NAEPP Coordinating Committee (CC), under the leadership of Claude Lenfant, M.D., Director of the NHLBI, convened the first Expert Panel in 1989. The charge to that Panel was to develop a report that would provide a general approach to diagnosing and managing asthma based on current science. Published in 1991, the "Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma" (EPR 1991) organized the recommendations for the treatment of asthma around four components of effective asthma management: Use of objective measures of lung function to assess the severity of asthma and to monitor the course of therapy; Environmental control measures to avoid or eliminate factors that precipitate asthma symptoms or exacerbations; Patient education that fosters a partnership among the patient, his or her family, and clinicians; Comprehensive pharmacologic therapy for long-term management designed to reverse and prevent the airway inflammation characteristic of asthma as well as pharmacologic therapy to manage asthma exacerbations. The NAEPP recognizes that the value of clinical practice guidelines lies in their presentation of the best and most current evidence available. This report presents recommendations for the diagnosis and management of asthma that will help clinicians and patients make appropriate decisions about asthma care.

This National Institutes of Health Publication 09-4977, "What I Need to Know About Colon Polyps," provides information on what colon polyps are, symptoms of colon polyps, preventing the occurrence of polyps, and obtaining treatment for polyps if you have them. A colon polyp is a growth on the surface of the colon, also called the large intestine. Sometimes, a person can have more than one colon polyp. Colon polyps can be raised or flat. The large intestine is the long, hollow tube at the end of your digestive tract. The large intestine absorbs water from stool and changes it from a liquid to a solid. Stool is the waste that passes through the rectum and anus as a bowel movement.

The adoption of local ordinances regulating the use or sale of tobacco represents an extraordinary social trend in the United States. Although such laws were virtually unheard of just a decade ago, hundreds of cities and counties across this country have taken aggressive action to control smoking in public settings as well as making it more difficult for minors to obtain tobacco. Major Local Tobacco Control Ordinances in the United States provides clear documentation of the extent to which local com- munities are enacting legislation to restrict or severely curtail tobacco use. The monograph also represents a social barometer regarding the seriousness with which communities view the smoking problem and the range of remedial actions taken to reduce tobacco use through socially responsible public policies. These ordinances are not based on social whim, however, but are based on decades of scientific research, which has increasingly documented the health consequences of tobacco for users and non-users alike. Since the early 1960's, medical science has left no doubt about the deadly nature of tobacco use, especially the practice of cigarette smoking. The scientific data base establishing a causal connection between smoking and increased death rates from various cancers, cardiovascular diseases, chronic obstructive lung diseases, fetal distress, and other chronic and debilitating conditions is truly staggering. Between 1960 and 1990, more than 60,000 scientific citations appeared in the worldwide literature linking cigarettes and other forms of tobacco use to these adverse health outcomes. Smoking is a health hazard in its own right, but smoking potentiates the risks of several environmental and occupational carcinogens. More than 400,000 premature deaths annually occur in the United States directly attributed to the effects of cigarette smoking. Of course, we should recall that even smokeless tobacco is a health hazard. Such high levels of death and disability affect us all, however, whether we smoke or not. In a comprehensive study conducted by the Congress' Office of Technology Assessment in 1985, it was estimated that cigarette smoking alone cost this Nation upwards of $95 billion annually. Given the spiraling increase in costs for both acute and long-term health care over just the last few years, such costs would be substantially greater in 1993 dollars. As a Nation, we simply cannot afford to pay for the health care costs associated with smoking. Major Local Tobacco Control Ordinances in the United States should also provide a tangible boost for local tobacco control policy development. It contains a comprehensive review of local and State tobacco control legislation, trends in tobacco control ordinances, and model laws for reducing both nonsmokers' exposure to ETS and youth access to tobacco products. It is, in short, a call to action to all who wish to improve the health of our Nation through reasonable and prudent public health policies that reduce tobacco addiction among our young and protect nonsmokers from the documented hazards of environmental tobacco smoke. Nevertheless, true prevention of smoking-related illnesses must depend on individual responsibility and action. Each of us as individuals must do our part.

This National Institutes of Health Publication 09-6443 addresses the burden of digestive diseases in the United States and how these digestive diseases include a wide spectrum of disorders affecting the oropharynx and alimentary canal, liver and biliary system, and pancreas. These disorders have diverse causes, including congenital and genetic anomalies, acute and chronic infections, cancer, adverse effects of drugs and toxins, and, in many cases, unknown causes. Some conditions, such as foodborne diarrheal diseases, are so common as to be considered a universal life experience, while many others are relatively uncommon or rare. The impact of these diseases ranges from the inconvenience of a transient diarrheal disease causing missed time from school or work, to chronic and debilitating illnesses requiring continuous medical care, or, all too frequently, to dreaded conditions such as pancreatic cancer that are usually fatal. During the 20th century, there were dramatic changes in the incidence, prevalence, and overall impact of digestive diseases in the United States that were the result of many factors, including improved sanitation and an improved food supply; numerous research discoveries that led to the development of new drugs, vaccines, diagnostic tests, and minimally invasive procedures; and an economic and health care system capable of providing these advances to the majority of the population. Continued progress in improving the health welfare of the population of the United States requires a continued investment in digestive disease research, public health initiatives, the health care system, and the education of the general public about how to improve their health. Accurate descriptive statistical information is one of the most basic types of information required by those engaged in activities aimed at improving digestive health, including researchers, administrators, public officials, professional and patient-based organizations, and the general public. In 1994, the National Institutes of Health (NIH) sponsored a publication, Digestive diseases in the United States: epidemiology and impact, that has served as a reference to meet these needs; the report had a limited update in 2001. Because of continuing changes in the incidence and prevalence of digestive diseases, important changes in health care, such as the emphasis on outpatient care whenever possible, and the availability of new statistical resources, the time is right to generate a new report to capture the impact of digestive diseases in the United States. In addition, congressional report language accompanying the Fiscal Year 2005 appropriations bills in the House and Senate for Labor-Health and Human Services-Education and Related Agencies called for the creation of an advisory committee, the National Commission on Digestive Diseases, and tasked it with addressing the burden of digestive diseases and developing a long-range research plan. The NIH sponsored the current report on the burden of digestive diseases to serve not only as a needed statistical reference, but also as a companion volume to inform research goals recommended in the Commission's research plan. Close examination of this report will reveal many interesting and provocative pieces of statistical information about trends in various digestive diseases. As outlined in the report, for any specific disease condition, there are numerous limitations on the types of data that can be obtained in the diverse and decentralized U.S. health care system.

Just as the American Stop Smoking Intervention Study for Cancer Prevention (ASSIST) was a major shift in the National Cancer Institute's (NCI's) tobacco prevention and control research and dissemination efforts, this monograph is a significant departure from NCI's previous tobacco control monographs. For many, the ASSIST project represented a logical progression of NCI's phased-research approach to reducing tobacco use. For others, it represented a controversial and overly ambitious leap in a new direction. Similarly, this monograph departs from the traditional quantitative evidence review format to emphasize instead the practical, hands-on experience of program implementation. Traditional research investigators who defend the sanctity of the randomized clinical trial, many of whom were uncomfortable with ASSIST at its outset, will also be uncomfortable with the personal and anecdotal flavor of this monograph. Public health practitioners, on the other hand, as well as those investigators who have immersed themselves in the untidy world of implementation research, will appreciate the detailed historical accounts of the complexities, politics, and outright opposition encountered by the ASSIST team. The collective experiences described in this monograph provide a rich understanding of the gritty struggle against the powerful forces of the tobacco industry and its allies. For students in public health training programs, this work also provides a unique view of the world outside of academia, where commercial, political, and public health interests collide in a struggle to define the policies, norms, and practices that will affect the health of generations. Monograph 16 begins with the historical context of ASSIST and the scientific base that informed the design of the project. The conceptual framework and the development of organizational infrastructures for implementation and evaluation are then described. The heart of this monograph is the in-depth descriptions of ASSIST's media advocacy and policy development interventions and the challenges posed by the tobacco industry. The monograph concludes by describing ASSIST's contributions to tobacco control and other behavioral health interventions and the significant challenges that remain.

This National Institutes of Health Publication 11-5755, "What I Need to Know About Celiac Disease," provides information from understanding what Celiac Disease is, what the symptoms are, and obtaining the proper treatment and proper nutrition for Celiac Disease. Celiac disease is an immune disease in which people can't eat gluten because it will damage their small intestine. Gluten is a protein found in wheat, rye, and barley. Gluten may also be used in products such as vitamin and nutrient supplements, lip balms, and some medicines. Other names for celiac disease are celiac sprue and gluten intolerance. Your body's natural defense system, called the immune system, keeps you healthy by fighting against things that can make you sick, such as bacteria and viruses. When people with celiac disease eat gluten their body's immune system reacts to the gluten by attacking the lining of the small intestine. The immune system's reaction to gluten damages small, fingerlike growths called villi. When the villi are damaged, the body cannot get the nutrients it needs.

The National Institutes of Health Publication 12-3536 Understanding Breast Changes: A Health Guide for Women provides information about breast changes, tests used to find changes, understanding test results and follow-up tests. You may be reading this booklet because you, or your health care provider, found a breast lump or other breast change. Keep in mind that breast changes are very common. Most breast changes are not cancer. But it is very important to get the follow-up tests that your health care provider asks you to.

Hepatitis C is a liver disease. Hepatitis means inflammation of the liver. Inflammation is the painful, red swelling that results when tissues of the body become injured or infected. Inflammation can cause organs to not work properly. This publication by the National Institutes of Health (Publication No. 09-4229) provides information about the causes, symptoms, diagnosis, and treatments for Hepatitis C. Other types of hepatitis exist. The National Institutes of Health has also provided additional publications about Hepatitis A - "What I Need to Know About Hepatitis A" - Publication No. 09-4244 - and Hepatitis B - "What I Need to Know About Hepatitis B" - Publication No. 09-4228.

The purpose of the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are: in those older than age 50, systolic blood pressure (SBP) of greater than 140 mmHg is a more important cardiovascular disease (CVD) risk factor than diastolic BP (DBP); beginning at 115/75 mmHg, CVD risk doubles for each increment of 20/10 mmHg; those who are normotensive at 55 years of age will have a 90 percent lifetime risk of developing hypertension; prehypertensive individuals (SBP 120-139 mmHg or DBP 80-89 mmHg) require health promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions, which are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (less than 140/90 mmHg, or less than 130/80 mmHg for patients with diabetes and chronic kidney disease); for patients whose BP is greater than 20 mmHg above the SBP goal or 10 mmHg above the DBP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will only be controlled if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the duodenum is called a duodenal ulcer. A peptic ulcer also may develop just above your stomach in the esophagus, the tube that connects the mouth to the stomach. But most peptic ulcers develop in the stomach or duodenum. This publication by the National Institutes of Health (Publication No. 11-5042) provides information about the causes, symptoms, diagnosis, and treatment of peptic ulcers.

Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a woman has a depressive disorder, it interferes with daily life and normal functioning, and causes pain for both the woman with the disorder and those who care about her. Depression is a common but serious illness, and most who have it need treatment to get better. Depression affects both men and women, but more women than men are likely to be diagnosed with depression in any given year. Efforts to explain this difference are ongoing, as researchers explore certain factors (biological, social, etc.) that are unique to women. Many women with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. There are several forms of depressive disorders that occur in both women and men. The most common are major depressive disorder and dysthymic disorder. Minor depression is also common. Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life. Dysthymic disorder, also called dysthymia, is characterized by depressive symptoms that are long-term (e.g., 2 years or longer) but less severe than those of major depression. Dysthymia may not disable a person, but it prevents one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes. Minor depression may also occur. Symptoms of minor depression are similar to major depression and dysthymia, but they are less severe and/or are usually shorter term. Some forms of depressive disorder have slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include the following: Psychotic depression occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality; seeing, hearing, smelling or feeling things that others can't detect (hallucinations); and having strong beliefs that are false, such as believing you are the president (delusions). Seasonal affective disorder (SAD) is characterized by a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy also can reduce SAD symptoms, either alone or in combination with light therapy.

All parents can relate to the many changes their kids go through as they grow up. But sometimes it's hard to tell if a child is just going through a "phase," or perhaps showing signs of something more serious. Recently, doctors have been diagnosing more children with bipolar disorder, sometimes called manic-depressive illness. But what does this illness really mean for a child? This booklet is a guide for parents who think their child may have symptoms of bipolar disorder, or parents whose child has been diagnosed with the illness. Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood and energy. It can also make it hard for someone to carry out day-to-day tasks, such as going to school or hanging out with friends. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. They can result in damaged relationships, poor school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives. Bipolar disorder often develops in a person's late teens or early adult years, but some people have their first symptoms during childhood. At least half of all cases start before age 25. To date, there is no cure for bipolar disorder. However, treatment with medications, psychotherapy (talk therapy), or both may help people get better.